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Modeling the risk of radiation pneumonitis in esophageal squamous cell carcinoma treated with definitive chemoradiotherapy

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Abstract

Background

To develop and validate a nomogram for the prediction of symptomatic radiation pneumonitis (RP) in patients with esophageal squamous cell carcinoma (ESCC) who received definitive concurrent chemoradiotherapy.

Methods

Clinical factors, dose-volume histogram parameters, and pulmonary function parameters were collected from 402 ESCC patients between 2010 and 2017, including 321 patients in the primary cohort and 81 in the validation cohort. The end-point was the occurrence of symptomatic RP (grade ≥ 2) within the first 12 months after radiotherapy. Univariate and multivariate logistic regression analyses were applied to evaluate the predictive value of each factor for RP. A prediction model was generated in the primary cohort, which was internally validated to assess its performance.

Results

In the primary cohort, 31 patients (9.7%) experienced symptomatic RP. Based on logistic regression model, patients with larger planning target volumes (PTVs) or higher lung V20 had a higher predictive risk of RP, whereas the overall risk was substantially higher for three-dimensional conformal radiotherapy (3DCRT) than intensity-modulated radiotherapy. On multivariate analysis, independent predictive factors for RP were smoking history (P = 0.035), radiotherapy modality (P < 0.001), PTV (P = 0.039), and lung V20 (P < 0.001), which were incorporated into the nomogram. The areas under the receiver operating characteristic curve of the nomogram in the primary and validation cohorts were 0.772 and 0.900, respectively, which were superior to each predictor alone.

Conclusions

Non-smoking status, 3DCRT, lung V20 (> 27.5%), and PTV (≥ 713.0 cc) were significantly associated with a higher risk of RP. A nomogram was built with satisfactory prediction ability.

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Acknowledgements

We thank all the patients who participated in this study.

Funding

This work was supported by grants from the Fundamental Research Funds for the Central Universities (19ykpy176) and Natural Science Foundation of Guangdong Province (2019A1515011420).

Author information

Author notes

  1. Kaiqi Lan, Cheng Xu and Shiliang Liu contributed equally to this study.

Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China

    Kaiqi Lan, Cheng Xu, Shiliang Liu, Jinhan Zhu, Yadi Yang, Li Zhang, Suping Guo & Mian Xi

  2. Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Kaiqi Lan

  3. Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China

    Cheng Xu, Shiliang Liu, Jinhan Zhu, Li Zhang, Suping Guo & Mian Xi

  4. Department of Imaging Diagnosis and Interventional Center, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Yadi Yang

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  1. Kaiqi Lan
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  2. Cheng Xu
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  8. Mian Xi
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Contributions

Conception and design: LZ, SG, MX. Acquisition of data: KQL, CX, SLL, MX. Analysis and interpretation of data: KQL, CX, SLL, JHZ, YDY, LZ, SG, MX. Writing, review, and/or revision of the manuscript: KQL, CX, SLL, JHZ, YDY, LZ, SG, MX. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Suping Guo or Mian Xi.

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Ethical Statement

This study was approved by the Institutional Review Boards of Sun Yat-sen University Cancer Center. Since this was a retrospective analysis of routine data, individual informed consent was waived from the ethics committee.

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The authors declare that there is no conflict of interest.

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Lan, K., Xu, C., Liu, S. et al. Modeling the risk of radiation pneumonitis in esophageal squamous cell carcinoma treated with definitive chemoradiotherapy. Esophagus 18, 861–871 (2021). https://doi.org/10.1007/s10388-021-00860-y

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  • DOI: https://doi.org/10.1007/s10388-021-00860-y

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